Are you optimistic or pessimistic about the future of urology?

"I 'm pessimistic about how we're going to be able to handle the aging population with limited resources. I'm also somewhat pessimistic in that I think funding for research and innovation in new technology will continue to decrease as well.

In general, we'll continue to have more patients to see. It could be a battle to learn how to streamline the inflow.

I'm sure we'll be busy in the future, but we will have to work harder for what we're making now. You always have debate about whether prostate cancer should be treated with radiation or surgery; that will continue. It's important for us to stay on top of the technological advances. Urologists need to be on the forefront of the technology advances in the future."

"The future of urology is good. There's a lot of urologic disease and with people living to be older, there will be a lot more people for urologists to treat. There will be no shortage of business. We'll have all the business we can handle; there will be a shortage of urologists.

I'm approaching the end of my career, but I enjoy my practice, the patients, and the people I work with. I want to hang in for a few more years, and I hope things won't be so difficult that we can't work. There's always going to be a demand; whether or not we'll be reimbursed fairly is the big unknown.

Even if you bring in mid-levels, there's certain things only urologists can do. There will be some care for which they may try to supplant us with primary care and mid-level providers, but a lot of PCPs and mid-levels aren't comfortable doing a lot of the things we do. They call us to do it. They send us patients every day that they don't want to deal with."

Nicholas Quinif, MD
Thomasville, GA

"My view of urology is quite optimistic because urology specializes in diseases that disproportionately affect the aging population. Looking at the demographics of our country, the patient base is increasing while the number of urologists is quite stable.

Different parts of the county have urologist shortages, and regional patient populations suffer from a lack of urologic care due to that. Readily available care for patients is a concern, but when it comes to a personal practice standpoint, urology should only improve.

Overall, unfortunately, the practice of medicine in this country is a concern given the uncertainty of physician reimbursement and the escalating costs of health care. In addition, the percentage of gross domestic product dedicated to health care seems to be growing at an unsustainable rate. At some point, it seems something will have to give. I fear it will be the physicians of this country who bear the financial brunt of that. We're going to be seeing more patients, but we'll be reimbursed less per patient."

Nicholas Leone, MD
Baltimore

"I 'm still very optimistic. Urology will require more and more people coming into the field because it's understaffed to meet the demand of the aging population in this country.

In addition, of all the different specialties, urology is still the most interesting in terms of innovation, with the advent of laparoscopic surgery, the use of robots for minimally invasive surgery, the emergence of extracorporeal shock wave lithotripsy, and advanced ways of performing minimally invasive surgery using endourology, ureteroscopy, etc. This is still the mindset in urology-to continue this kind of innovative process.

Our practice has been growing and expanding though the recession, so I am optimistic for the future of urology. Potential changes in health care may hinder some progress, but no one knows for sure. Despite that, we're moving on and progressing."

Nicholas Franco, MD
Naples, FL

Karen Nash is a medical reporter and media consultant based in Sioux Falls, SD.